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Always Look Behind The Curtain First

2010 August 14
Posted by Nurse Me


I’m a nurse but I’m also human. I have human reactions to humans despite patient and popular perception that, as a nurse, I should be morally, ethically and heroically superior. This misconception along with my facial expressions often gets me into trouble.

 “Hey, Nurse Me, can you help me try and start a line?”

“Sure,” I said reflexively.

I’m honored. Someone needs my help and not any someone. A veteran “go to” nurse is having a problem starting an IV and he is asking for my help. Huge ego rush. Huge.

I round the corner with all the excitement of a child at Christmas expecting a cute little bow wrapped puppy under the tree but got dog poo instead. My mouth fell agape, my nose crinkled and my eyes widened becoming fixed on my veteran co-worker in a you’ve-got-to-be-shitting-me stare. None of this is lost on the patient.

 “Yes, I know, I’m big.”

Big doesn’t even begin to cover it. This patient is HUGE. His last recorded weight is 722 pounds!

700 and 22 pounds!

That’s beyond huge, that’s gross.

Obesity shouldn’t be an extreme sport.

Now I know that as a nurse I must be prepared to see any and all sorts of anomalies, and I am. I can look at a maggot infested leg wound and not flinch, mainly because I’m not bothered by maggots. I can watch someone vomit without so much as a facial tic as if Nicole Kidman’s esthetician shot me full of Botox. I can pull brains out of someone’s nose without so much as a gag. And I can listen to someone with kidney stones scream in agony as if I am deaf. None of these things bother me.

But face me with someone who could lose 2.5 times the weight of the average man in America and still be obese and I’m beyond bothered.

How do you let yourself get so fat that you can no longer clean 90% of your body? How do you let yourself get so fat that you have no idea what most of your body looks like? How do you let yourself get so fat that brushing your teeth makes you winded? How do you let yourself get so fat that standing is a near impossibility? How do you let yourself get so fat that you can’t even wipe your own ass? HOW DO YOU LET YOURSELF GET SO FAT?

I want a puppy.

Being that fat isn’t healthy. You have diabetes, joint pain, sleep apnea, organomegaly, high cholesterol, shortness of breath and osteoporosis not to mention the odor. The odor that accompanies the schmegma living in the fat folds that your pudgy little hands and arms can’t clean and deschmegmatize.

Our treatment options are limited. We can’t take you to CT Scan should you require it because there’s a weight limit, 400/450 pounds. You won’t fit in an MRI machine, most xrays can’t be done because not even the maximum dose of radiation will penetrate your fat and we (at least at my hospital) will no longer send you to the zoo to have these procedures done because we now consider that inhumane, degrading and embarrassing for you. (This is not a joke; I’ve actually worked at hospitals where our extremely obese patients are sent to the zoo for scans.  Dumbo comes of the table, my patient goes on the table.) If my partner and I can’t get an IV, you’ll need a cut down. And that shortness of breath with a ”touch of CHF” you’re experiencing is going to require the insertion of a foley (pee tube). I have no idea how you pee and clean yourself at home but here, in the hospital, we really would like to keep you clean and dry, to reduce your already astronomical risk for infection, specifically Fournier’s. I’ve been there before and NEVER want to go back.

And trust me, I’m far from thrilled about having to insert a foley. It will take a minimum of 7 people: 2-3 people to lift and hold your pannus, 1 person to hold and lift your FUPA (fatty upper penis area), 2 people to hold back your fatty thighs, 1-2 people to apply pressure around your penis to get it to pop out like a turtle’s head and finally 1 person to clean you penis and insert the foley. I think I’d prefer a trip to the zoo. And a puppy. All this is swirling in my mind with my crinkled nose, agape mouth and widened eyes.

I take position on the left side of the bed to look for a vein while making idle conversation.

“Are you having any luck?”

“Not yet.”

“Mr. Hut, where’s the best place to find a vein?”

“I don’t know.”

“Why did you come to the hosp…,” my mouth froze in mid sentence, the words trapped by my paralyzed vocal cords. From the corner of my right eye, I see something dark move across Hut’s chest. I look up and lock eyes with my partner with a you-just-saw-that, right? expression on my face. From his return stare, he did. And then the patient:

“I’m sorry about that.”

My partner and I remain speechless, not quite sure of the etiquette in this situation. And even before my brain can unfreeze to think of something to say, there it is, the black blur I thought I had seen is now resting on Hut’s right shoulder.


In addition to everything else, Hut has cockroaches living in his fat folds.


I drop my equipment and swiftly exit Hut’s room leaving the veteran behind, quivering and scratching my body as if it were infested with cockroaches. There are 3 things in this world that I have an adverse reaction to and 2 of them just smacked me in the face. I still feel guilty for falling short of my professional responsibilities but sometimes I just have to be human.

Heed my warning young RNs, always look behind the curtain first.


12 Responses
  1. erica rose permalink
    August 14, 2010

    So… what did you do after that?

  2. Nurse Me permalink
    August 15, 2010

    I walked away to compose myself, asked another nurse to assist the veteran (with warning first) and then took care of my patients. After Mr. Hut was admitted to the ICU, I apologized to the veteran. He said he completely understood.

  3. Carol RN permalink
    August 15, 2010

    Wow this is so true. Everyone thinks nurses are super human.

  4. Jo Ann RN permalink
    August 16, 2010

    Patients are getting more obese by the minute! My hospital did bariatric surgery with limits on the maximum weight of the pts in their service. But the pts we performed other surgical procedures on, many times outweighed the bariatric pts. You’re correct regarding the catheter insertion, also try putting someone like that in stirrups. Or just transferring them from stretcher to surgical table & back again. You hope you have the staff available… It’s difficult to remain objective & compassionate & not worry about one’s back!

  5. August 16, 2010

    Omg I laughed through this entire post…. until the cockroach part and then i was literally gagging. honestly, i always think to myself….”if people REALLY knew what i was thinking right now, they wouldnt let me be their nurse” haha sad but so very true.

  6. Nurse Me permalink
    August 16, 2010

    Is it shameful to admit that usually the first thoughts to cross our mind with the extremely obese is our backs? Or how many resources its going to take to attempt to take care of one patient? Or hoping that the stretcher doesn’t break because who’s going to pick him up off the floor?

  7. Nurse Me permalink
    August 16, 2010

    Andi –
    Don’t you think that sometimes patients should know what we’re thinking?

  8. girlvet permalink
    August 20, 2010

    Oh my God. Anyone would have run from the room. We really do deserve combat pay.

  9. August 23, 2010


    ….For years, my Worst Story About A Patient’s Morbid Obesity was a nurse who was cleaning her extremely obese patient and found a Twinkie amidst the folds. The patient blushed, and said that she and her husband sometimes played *cough* games to….uh,…find the Twinkie. She tittered that she “guessed they missed one.”

    That had been my topper.

    But. You win. The cockroach wins.

    I wish we could just deny Medicare/Medicaid coverage for people over, say, 400lbs. I don’t want to pay for that self-destruction. Or for the cockroaches, to…ew.

    Just. ew.

  10. Nurse Me permalink
    August 23, 2010

    The image that comes to mind whenever I hear the phrase/euphemism “hide the twinkie” is now forever changed. Thanks for that! >p
    This is why I believe that mental health counseling should be mandatory or, at the very least included in Obama’s national health plan.
    Self destructive behavior INDEED!

  11. September 30, 2010

    other than the cockroach..the whole foley thing…is the exact pic of me helping with my “veteran nurses” cath this 680lb man. it took 7 of us. And the hardest part was trying to keep him from falling off the ER stretcher since he didn’t fit. Not to mention he was breath hard and it took 4 to lift the back of the stretcher to help him sit up. and even more impossible to do CPR…one of the nurses had to straddle him to get effective compression…mine didn’t have the cockroaches…but was covered in his own filth. Mama was bringing him food to the floor that he was laying on. Because he fell over and laid on the floor for 1 week. He had dried crap and urine on him. you could smell him in the hall…ugh makes me shutter

  12. Nurse Me permalink
    October 1, 2010

    The lengths we go to save a life. Unfortunately this type of picture is becoming all too common.

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